Clinical Question

Is mortality improved in patients with left main coronary artery disease that is managed with coronary artery bypass grafting (CABG) or percutaneous interventions (PCI) with drug-eluting stents?

Bottom Line

The five- and 10-year all-cause mortality rates are similar in people with left main coronary artery disease whether it is managed with PCI with drug-eluting stents or with CABG. (Level of Evidence = 1a)

Synopsis

The team searched several databases and identified four randomized trials that compared PCI (n = 2,197) with CABG (n = 2,197) in adults with left main coronary artery disease and reported five-year mortality outcomes. The authors were able to obtain the data on the individual participants in these trials. Three of the trials recruited only people with left main disease. Although the fourth trial included people with multivessel disease, the authors were able to isolate the subgroups with left main disease. After five years, there was no significant difference in all-cause mortality between the two groups (slightly more than 10%), and no significant difference in cardiovascular and non-cardiovascular deaths. The authors found no significant difference in 10-year mortality (slightly more than 20%). The patients whose left main coronary artery disease was managed by PCI had slightly more spontaneous myocardial infarctions (6.2% vs. 2.6%; number needed to harm = 31; 95% CI, 23 to 47) and subsequent revascularizations (18.3% vs. 10.7%; number needed to harm = 14; 95% CI, 11 to 19).

Study design: Meta-analysis (randomized controlled trials)

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)

Reference: Sabatine MS, Bergmark BA, Murphy SA, et al. Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis. Lancet. 2021;398(10318):2247-2257.